The Next Step After Physical Therapy

“I failed Physical Therapy”

This self-effacing statement came from “Bonnie,” my newest client. Bonnie went on to tell me the whole sordid story of her back pain, which developed over the last several years: courses of treatment including chiropractic, physical therapy, and epidurals, followed by more pain, and more physical therapy.

“I’m the perfect patient,” she says. “I do everything they tell me to. My pain starts to abate, the PT discharges me and tells me to resume ‘normal activity,’ and then within a week, my pain is back.”

Unfortunately, this is a familiar story. But Bonnie didn’t actually “fail” physical therapy. She just had failed expectations.

Failed Expectations

Bonnie thought that after completing physical therapy, she would be “as good as she was prior to her back injury.”

There are 2 mistakes in that notion:

1. Returning to the state she was in prior to injury is no good—that’s how she was injured. She needs to return to a healthier version of herself that can resist injury and thrive amid her preferred activities.

2. Physical Therapists are discharging patients sooner than they did 10 years ago. Much of that is due to insurance restrictions. Insurance companies will only pay for a certain number of Physical Therapy visits. This leads to earlier discharge, many times before the patient – or the Physical Therapist- is ready. Although patients may experience a reduction in symptoms and even some functional improvements, it is rare that they are strengthened/ stabilized/ conditioned to tolerate anything much beyond their activities of daily living. For this reason, as the patient returns to a favorite sport, goes on a long trip requiring handling luggage and walking through airports, or even decorating for a major holiday, their pain returns.

The “obvious” question:“Can you help me?”

This is a great question, especially when someone feels they are in a loop: pain-PT-normal activity-pain- PT, so on. I asked Bonnie a few more questions. I learned that her pain was no longer acute, nor was it severe. Her physical therapist referred her to us because he felt she needed a movement-based solution rather than a treatment-based one. He agreed to be on standby for manual work as needed, but wanted us to help her learn how to stabilize her spine, re- balance the muscles around her hips, and get her moving efficiently and well again.

Would she ever be able to hike in the mountains again? What about gardening? These were some of her favorite activities, but they seemed to be “hard on her back.” Although I had no crystal ball, and could only assure her based on my experience with clients who adhered to our program, I believed she could.

A note about Physical Therapy Physical Therapy is an important step in the recovery process for many musculoskeletal conditions. Physical Therapists can medically treat inflammation and pain, allowing for better tissue healing and restoration of function (movement.) Medical Exercise Specialists are not medically licensed. At our core, we are highly trained professionals, who use exercise as a means to restore healthy movement. Our work does not take the place of good physical therapy or medical treatment. In fact, many times, our practitioners work in collaboration with physical therapists and other healthcare providers to give you a comprehensive recovery plan.

If you are completing physical therapy, or have completed therapy in the past but continue to have a recurrence of your symptoms, ask your doctor or physical therapist if medical exercise could be a good next step for you. Let’s break the cycle of re-injury and get you moving again!